Excessive anger is often observed in people with PTSD and other anxiety-related disorders. In PTSD, a propensity towards excessive anger may be apparent before exposure to a trauma, for example as a personality trait. Or it could be a result of exposure to the trauma itself and a symptom of PTSD. Elevated anger in people with PTSD has clinical implications as it may be a barrier to effective treatment outcomes. Therefore, anger and aggression are key targets for improvement early in the treatment process.

What is the evidence for anger and aggression in people with PTSD?

Moderate to high quality evidence finds a large increase in difficulty with anger in people with PTSD than in people without PTSD. There were high levels of anger and hostility in veterans, police, and firefighters prior to exposure to trauma and development of PTSD.

In veterans post-deployment, the overall prevalence of any aggressive behaviour is around 36%, which is significantly higher than in veterans who have not had combat exposure. Veterans deployed to combat situations who subsequently develop PTSD show the highest levels of aggressive behaviour, particularly if they also misuse alcohol.

August 2021

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Agitation and/or aggression are sometimes observed during a psychiatric emergency such as in onset of acute psychosis. Agitation typically includes irritability and restlessness, motor or verbal hyperactivity, uncooperativeness, and occasionally aggressive gestures or behaviour. This can pose a risk both to the individual, as well as the attending health care professionals, and so is important to manage this behaviour and prevent potential harm.

What is the evidence for treatments for aggression and agitation?

Moderate to low quality evidence suggests intramuscular olanzapine (10mg x 2 doses + 5mg x 1 dose), inhaled loxapine (5 or 10mg), or intramuscular aripiprazole (9.75 or 15mg) are more effective at reducing agitation in people with bipolar disorder than placebo or lorazepam.

November 2021

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